https://mahfujalampt.wixsite.com/website

Physiotherapist Mahfuj Alam, Satmasjid Road, Dhanmondi, Dhaka (2026)

03/02/2026

A (herniated, ruptured, or slipped disc) occurs when the soft jelly-like center of a spinal disc pushes through a tear in its outer ring, often irritating nearby nerves. Common in the lower back (lumbar) after age 35, it causes pain, numbness, or weakness, frequently radiating down the legs. Most cases resolve within 4–6 weeks with conservative treatments like rest, pain relief, and physiothephysiotherapy.

Aspects of Disc Prolapse:

: Intense pain often described as a deep ache or sharp, stinging pain (sciatica if in the leg), which can worsen with sneezing, bending, or prolonged sitting.

: Age-related wear (degeneration) or sudden strain from heavy lifting, twisting, or poor posture.

: Doctors use physical exams to check for numbness or weakness, often confirming with MRI scans.

Treatment: Over-the-counter NSAIDs (anti-inflammatories), muscle relaxants, physical therapy, and modifying activities.

to Seek Immediate Care: If you experience severe, worsening leg weakness, numbness in the saddle area, or loss of bowel/bladder control, seek immediate medical attention, as this may indicate cauda equina syndrome.

: If pain persists after several weeks, or if symptoms are severe, surgical options like microdiscectomy (keyhole surgery) may be recommended to remove the damaged disc material.

Locations :

Spine (Lower Back): Most common, often resulting in sciatica (pain down the leg).

Spine (Neck): Can cause pain, numbness, or weakness in the arms or shoulder 🦴

02/02/2026

Tendon Vs Ligament ✅

🦴 TENDON

→ Connects muscle to bone
→ Made of dense, parallel collagen fibers (very strong, low elasticity)
→ Transfers force generated by muscle contraction to bone
→ Enables movement at joints
→ Poor blood supply → heals slowly when injured
→ Examples: Achilles tendon, biceps tendon

🦴 LIGAMENT

→ Connects bone to bone
→ Made of collagen fibers with slight elasticity
→ Provides joint stability and alignment
→ Prevents excessive or abnormal joint movement
→ More elastic than tendons, but still strong
→ Examples: ACL, PCL, medial collateral ligament

⭐ KEY DIFFERENCE TO REMEMBER

→ Tendon = Movement (muscle pulls bone)
→ Ligament = Stability (bone holds bone)

02/02/2026

Effective plantar fasciitis exercises at home.💪🏻🏋🏻

01/02/2026

Manual muscle testing of the neck
Part 1-(Captital extension )

01/02/2026

Sitting is the new smoking. 🚫🪑
Your spine needs movement, not medicine.
Exercise daily. Protect your back.
✔️ Targeted exercises
✔️ Posture correction
✔️ Consistency

30/01/2026

: See the lumbar levels up close, with a prominent L3-4 disc herniation pressing on the nerve root. Labeled landmarks like pedicles, pars, and facets make this perfect for learning why pain radiates down the leg.

29/01/2026

(Psoas Major)
The psoas major is a long, thick, deep muscle of the posterior abdominal wall. It plays a key role in hip flexion, lumbar spine stability, posture, and functional movements like walking, running, and rising from sitting. It works closely with the iliacus and together they form the iliopsoas, the primary hip flexor.

Origin

√Sides of the vertebral bodies of T12 to L5
√Intervertebral discs between T12–L5
√Transverse processes of L1–L5

Insertion

√Lesser trochanter of the femur (via a common tendon with the iliacus)

Muscle Fiber Direction

√Fibers run downward, forward, and laterally from the lumbar spine to the femur

√Lumbar plexus
√Nerve roots: L1–L3 (sometimes L4)

Supply

√Lumbar arteries
√Iliolumbar artery

Primary Actions

√Powerful hip flexion (especially from a standing position)
√Assists in external rotation of the hip

Secondary Actions

√Stabilizes the lumbar spine
√Assists in lumbar flexion when the femur is fixed
√Helps maintain upright posture

Role

√Walking and running (swing phase of gait)
√Stair climbing
√Sitting up from lying
√Postural control, especially in prolonged sitting

Importance

Tight or Short Psoas

√Common in people with prolonged sitting.

Effects:

√Increased lumbar lordosis
√Anterior pelvic tilt
√Low back pain
√Hip pain or groin discomfort

Weak Psoas

Effects:

√Poor hip flexion strength
√Difficulty with stair climbing or sit-to-stand
√Reduced trunk stability

Physical Examination

√Thomas Test: assesses psoas tightness
√Palpation (deep, medial to ASIS, done carefully)

Observation

√Postural analysis for anterior pelvic tilt
√Gait assessment

Management

For Tight Psoas

√Iliopsoas stretching (lunging hip flexor stretch)
√Myofascial release
√Postural correction
√Activity modification

For Weak Psoas

√Supine straight leg raises
√Marching exercises
√Resistance hip flexion
√Core stabilization exercises

Conditions

√Psoas syndrome
√Low back pain
√Hip flexor strain
√Lumbar disc pathology (referred pain)

29/01/2026

is a group of four muscles and their tendons—supraspinatus, infraspinatus, teres minor, and subscapularis—that stabilize the shoulder joint (connecting the humerus to the scapula) and enable arm rotation and lifting. Common injuries include tears or tendinitis, causing pain, weakness, and limited range of motion.

of Injury :

Pain: A dull, deep ache in the shoulder that is often worse at night, particularly when sleeping on the affected side.

Weakness: Difficulty lifting, rotating, or raising the arm, especially overhead.

Mobility Issues: Pain with tasks like brushing hair or reaching behind the back.

Sounds: A clicking or grating sensation (crepitus) with movement.

and Risk Factors :

Degeneration: Wear and tear associated with aging (common in people over 40).

Repetitive Use: Overhead sports (baseball, tennis, swimming) or occupations requiring repetitive arm motions.

Acute Injury: A sudden tear from a fall on an outstretched hand or lifting heavy objects.

and Treatment :

Diagnosis: Physical exam, X-rays, MRI, or ultrasound to check for tears, inflammation, or bursitis.

Non-Surgical Treatments: Most injuries improve with rest, activity modification, anti-inflammatory medication, and physical therapy to strengthen the surrounding muscles.

Surgical Treatments: Surgery may be required for significant tears or if pain persists after conservative treatments. 🦴

28/01/2026

Shoulder Test ⚙️🔢

28/01/2026

Glenoid Labrum Tear is an injury to the fibrocartilaginous rim that surrounds the glenoid fossa of the shoulder. The labrum deepens the socket, improves stability, and serves as an attachment for the joint capsule, ligaments, and the long head of the biceps tendon. When it tears, shoulder stability and smooth movement are affected.

√The glenoid is shallow, almost like a golf tee
√The labrum increases socket depth by about 50 percent
√Superior labrum blends with the biceps tendon
√Inferior labrum contributes most to shoulder stability

of labral tears

1. SLAP tear (Superior Labrum Anterior to Posterior)

√Involves the top part of the labrum
√Often related to overhead activity or traction injuries
√Common in throwers and weightlifters

2. Bankart lesion

√Tear of the anteroinferior labrum
√Usually associated with anterior shoulder dislocation
√Leads to recurrent instability

3. Posterior labral tear

√Less common
√Seen in contact with athletes or after posterior dislocation

4. Degenerative labral tear

√Age-related fraying
√Often asymptomatic and incidental on imaging

√Traumatic dislocation or subluxation
√Repetitive overhead movements
√Sudden traction on the arm
√Falls on an outstretched hand
√Degenerative changes with aging

√Deep, poorly localized shoulder pain
√Catching, clicking, or locking sensations
√Feeling of instability or “dead arm”
√Pain with overhead or cross-body movements
√Reduced strength and endurance

tests (suggestive, not definitive)

√O’Brien’s test
√Crank test
√Speed’s test (for SLAP involvement)
√Apprehension and relocation tests (Bankart)

√Clinical history and examination are key
√MRI arthrogram is the most sensitive imaging
√Standard MRI may miss smaller tears
√Arthroscopy remains the gold standard

√Conservative (first line in many cases)
√Activity modification
√Pain and inflammation control
√Physiotherapy focusing on:
√Rotator cuff strengthening
√Scapular stabilizer training
√Proprioception and neuromuscular control
√Gradual return to overhead activity

Many patients, especially non-athletes, do well without surgery.

Surgical

√Indicated for persistent symptoms or recurrent instability
√Arthroscopic labral repair or debridement
√Followed by structured rehabilitation

rehabilitation

Early phase

√Protect repair or reduce irritation
√Restore pain-free range of motion

Intermediate phase

√Strengthen rotator cuff and scapular muscles
√Improve dynamic stability

Advanced phase

√Sport- or work-specific drills
√Gradual loading and return to function.

28/01/2026

Dermatomes of the body 𖨆

27/01/2026

( )

History and Risk Factors
Primary Cause: Herniated intervertebral discs account for 90% of cases, typically at the L4–L5 or L5–S1 levels.

Other Causes: Spondylolisthesis, spinal stenosis, or rare serious pathologies like infection (discitis) or malignancy.

Risk Profile: Most common in middle-aged patients, smokers, and those in occupations involving heavy driving or vibrating equipment.

Symptoms and Red Flags

Pain Characteristics: Sharp, burning leg pain (with or without back pain) radiating down the posterior or lateral leg to the foot.

Mechanical Behavior: Often worsened by sitting, bending, coughing, or sneezing ("impulse pain"), and eased by standing.

Neurological Features: Numbness, paresthesia, or motor weakness (e.g., a "slapping" foot during walking).

Cauda Equina Warning Signs
Immediate investigation is required if the following occur:

Bilateral sciatica or progressive neurological deficit.

Urinary retention or impaired flow.

Bowel incontinence or loss of fullness sensation.

Numbness in the "saddle" area (perineal/genital region).

Physical Examination
Testing focuses on identifying the specific nerve root level involved:

L4 Root: Look for reduced foot dorsiflexion (difficulty heel walking) and a diminished patellar reflex.

L5 Root: Look for reduced great toe extension (dorsiflexion).

S1 Root: Look for reduced foot plantar flexion (difficulty toe walking) and a diminished ankle reflex.

Sensory: Check for asymmetrical reduced sensation in specific dermatomes.

Special Tests: The Straight Leg Raise and Slump Test are used to provoke neural tension.

Management Strategy

Conservative Care
This is the first-line approach for the first 4–6 weeks:

Education: Reassurance regarding the natural healing process.

Physiotherapy: Stretching, strengthening, and neurodynamic exercises (nerve gliding) to reduce sensitivity.

Postural Re-education: Adjusting daily habits to reduce nerve irritation.

Medical and Surgical Intervention

Medication: NSAIDs or neuropathic painkillers (e.g., Gabapentin) based on local guidelines.

Injections: Epidural corticosteroids for severe or persistent acute pain.

Surgery (Discectomy/Laminectomy): Reserved for urgent cases (major weakness/foot drop) or persistent pain that fails conservative management.

Physiotherapist Mahfuj Alam

03/02/2026

02/02/2026

02/02/2026

01/02/2026

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27/01/2026

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